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New Chilean study shows banning abortion does not increase maternal mortality

by | May 12, 2012

Dr. Elard S. Koch

By Paul Stark

A new study analyzes the incidence of maternal mortality in Chile and demonstrates that it is “not related to the legal status of abortion,” contrary to the claims of international abortion advocates who use maternal deaths as an argument for the legalization of abortion. The study, led by Dr. Elard Koch of the University of Chile, was published May 4 in the peer-reviewed scholarly journal PLoS ONE.(www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0036613)

Over a span of 50 years (1957 to 2007), the researchers note, the maternal mortality ratio (MMR) in Chile declined dramatically — from 293.7 to 18.2 deaths per 100,000 live births, a decrease of 93.8 percent. (It dropped to 16.5 in 2008.) Abortion was banned in Chile in 1989, and the MMR continued to decline significantly and at the same pace.

“After abortion was prohibited, the MMR decreased from 41.3 to 12.7 per 100,000 live births (−69.2%),” explain the authors. “The slope of the MMR did not appear to be altered by the change in abortion law.” Even maternal deaths due specifically to abortion declined — from 10.78 abortion deaths per 100,000 live births in 1989 to 0.83 in 2007, a reduction of 92.3 percent after abortion was banned. The abortion mortality ratio plummeted 99.1 percent from 1961 to 2007.

Thus Chile, which prohibits abortion, now has the lowest MMR in Latin America and the second lowest in all of North and South America. And maternal death due specifically to (illegal) abortion is now “practically null.”

Yet many in the international community, and groups like the International Planned Parenthood Federation, contend that prohibiting abortion leads to increased maternal mortality, and legalizing abortion leads to decreased maternal mortality. That was not true in Chile, and there is no reason to think it is true anywhere else. Koch, et al., write (notes omitted):

The validity of this assumption depends on whether the legal status of abortion is causally associated with the prevalence of illegal abortion, the safety of the abortive procedure, and maternal morbidity and mortality exhibited in general. Nevertheless, no direct evidence testing this causal assumption in developing countries currently exists. Furthermore, the lowest MMRs observed in European countries such as Ireland, Malta and Poland, where abortion is severely restricted by law, suggest that this assumption may be untrue.

After 1989, Chile is recognised as one of the countries with the most restrictive abortion laws in the world and has been criticised because of the purported possible deleterious consequences on maternal health. Nevertheless, the present study provides counterintuitive evidence showing that making abortion illegal is not necessarily equivalent to promoting unsafe abortion, especially in terms of maternal morbidity and mortality. Chile’s abortion prohibition in 1989 did not cause an increase in the MMR in this country. On the contrary, after abortion prohibition, the MMR decreased from 41.3 to 12.7 per 100,000 live births — a decrease of 69.2% in fourteen years. Excluding ectopic pregnancy, the absolute risk of death due to unspecified abortion is one in two million women at fertile age. Our study indicates that improvements in maternal health and a dramatic decrease in the MMR occurred without legalization of abortion. This does not imply that there are no illegal or clandestine abortions in Chile. Rather, current abortion mortality ratio and recent epidemiologic studies of abortion rates in this country suggest that clandestine abortion may have been reduced in parallel with maternal mortality and may have currently reached a steady state based on stable ratios between live births and hospitalizations by abortion.

What does affect maternal mortality? The Koch study cites various factors in Chile, such as a significant increase in education level, “access and utilization of maternal health facilities” (including “early prenatal care, delivery by skilled birth attendants, postnatal care, availability of emergency obstetric units and specialized obstetric care”) and “improvements of the sanitary system.” We should work in the developing world to improve basic maternal health care. Deaths can be dramatically reduced just as they were in Chile and in the developed world, including the United States (where maternal mortality rates dropped well before abortion was legalized). Abortion has nothing to do with it.

Nations that prohibit abortion should not be bullied into legalizing the practice on the grounds that doing so is necessary for women’s health. As the Chilean example shows, that’s simply not true.

Editor’s note. Paul Stark is Communications for Minnesota Citizens Concerned for Life, NRLC’s state affiliate. This appears at http://prolifemn.blogspot.com/2012/05/new-chilean-study-shows-banning.html

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